Catastrophic acute failure of pelvic fixation in adult spinal deformity requiring revision surgery: a multicenter review of incidence, failure mechanisms, and risk factors.

Autor:	Martin CT; 1Department of Orthopaedic Surgery, University of Minnesota, Minneapolis., Holton KJ; 1Department of Orthopaedic Surgery, University of Minnesota, Minneapolis., Elder BD; 2Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota., Fogelson JL; 2Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota., Mikula AL; 2Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota., Kleck CJ; 3Department of Orthopedics, University of Colorado, School of Medicine, Aurora, Colorado., Calabrese D; 3Department of Orthopedics, University of Colorado, School of Medicine, Aurora, Colorado., Burger EL; 3Department of Orthopedics, University of Colorado, School of Medicine, Aurora, Colorado., Ou-Yang D; 3Department of Orthopedics, University of Colorado, School of Medicine, Aurora, Colorado., Patel VV; 3Department of Orthopedics, University of Colorado, School of Medicine, Aurora, Colorado., Kim HJ; 4Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York., Lovecchio F; 4Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York., Hu SS; 5Department of Orthopaedic Surgery, Stanford University, Stanford, California., Wood KB; 5Department of Orthopaedic Surgery, Stanford University, Stanford, California., Harper R; 5Department of Orthopaedic Surgery, Stanford University, Stanford, California., Yoon ST; 6Department of Orthopaedics, Emory University, Atlanta, Georgia., Ananthakrishnan D; 6Department of Orthopaedics, Emory University, Atlanta, Georgia., Michael KW; 6Department of Orthopaedics, Emory University, Atlanta, Georgia., Schell AJ; 6Department of Orthopaedics, Emory University, Atlanta, Georgia., Lieberman IH; 7Scoliosis and Spine Tumor Center, Texas Back Institute, Plano, Texas., Kisinde S; 7Scoliosis and Spine Tumor Center, Texas Back Institute, Plano, Texas., DeWald CJ; 8Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois., Nolte MT; 8Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois., Colman MW; 8Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois., Phillips FM; 8Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois., Gelb DE; 9Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland., Bruckner J; 9Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland., Ross LB; 10Department of Neurologic Surgery, Cedars-Sinai Medical Center, Los Angeles., Johnson JP; 10Department of Neurologic Surgery, Cedars-Sinai Medical Center, Los Angeles., Kim TT; 11Department of Orthopaedics, Cedars-Sinai Medical Center, Los Angeles, California., Anand N; 11Department of Orthopaedics, Cedars-Sinai Medical Center, Los Angeles, California., Cheng JS; 12Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio; and., Plummer Z; 12Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio; and., Park P; 13Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan., Oppenlander ME; 13Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan., Sembrano JN; 1Department of Orthopaedic Surgery, University of Minnesota, Minneapolis., Jones KE; 1Department of Orthopaedic Surgery, University of Minnesota, Minneapolis., Polly DW; 1Department of Orthopaedic Surgery, University of Minnesota, Minneapolis.
Jazyk:	angličtina
Zdroj:	Journal of neurosurgery. Spine [J Neurosurg Spine] 2022 Sep 02; Vol. 38 (1), pp. 98-106. Date of Electronic Publication: 2022 Sep 02 (Print Publication: 2023).
DOI:	10.3171/2022.6.SPINE211559
Abstrakt:	Objective: There are few prior reports of acute pelvic instrumentation failure in spinal deformity surgery. The objective of this study was to determine if a previously identified mechanism and rate of pelvic fixation failure were present across multiple institutions, and to determine risk factors for these types of failures. Methods: Thirteen academic medical centers performed a retrospective review of 18 months of consecutive adult spinal fusions extending 3 or more levels, which included new pelvic screws at the time of surgery. Acute pelvic fixation failure was defined as occurring within 6 months of the index surgery and requiring surgical revision. Results: Failure occurred in 37 (5%) of 779 cases and consisted of either slippage of the rods or displacement of the set screws from the screw tulip head (17 cases), screw shaft fracture (9 cases), screw loosening (9 cases), and/or resultant kyphotic fracture of the sacrum (6 cases). Revision strategies involved new pelvic fixation and/or multiple rod constructs. Six patients (16%) who underwent revision with fewer than 4 rods to the pelvis sustained a second acute failure, but no secondary failures occurred when at least 4 rods were used. In the univariate analysis, the magnitude of surgical correction was higher in the failure cohort (higher preoperative T1-pelvic angle [T1PA], presence of a 3-column osteotomy; p < 0.05). Uncorrected postoperative deformity increased failure risk (pelvic incidence-lumbar lordosis mismatch > 10°, higher postoperative T1PA; p < 0.05). Use of pelvic screws less than 8.5 mm in diameter also increased the likelihood of failure (p < 0.05). In the multivariate analysis, a larger preoperative global deformity as measured by T1PA was associated with failure, male patients were more likely to experience failure than female patients, and there was a strong association with implant manufacturer (p < 0.05). Anterior column support with an L5-S1 interbody fusion was protective against failure (p < 0.05). Conclusions: Acute catastrophic failures involved large-magnitude surgical corrections and likely resulted from high mechanical strain on the pelvic instrumentation. Patients with large corrections may benefit from anterior structural support placed at the most caudal motion segment and multiple rods connecting to more than 2 pelvic fixation points. If failure occurs, salvage with a minimum of 4 rods and 4 pelvic fixation points can be successful.
Databáze:	MEDLINE
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